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What is the cause for toes turn blue, muscle pain in chest, arms, legs, and back, rash on face and arms?

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Allergist and Immunologist
Practicing since : 1999
Answered : 584 Questions
I see a rhematologist due to a positive ana test 1:640 when repeated 1:340 , have many things that point to lupus yet lupus was negative. toes turn blue when cold, muscle pain in chest, arms, lega, and back, rash on face and arms that is worse with sun but yet still present and red in winter. My rheumatologist advised me to seek a second opinion with a rheumatologist. Why ?
Posted Mon, 16 Dec 2013 in Lupus
Answered by Dr. Sujoy Khan 3 hours later
Brief Answer: Need ANA antibody panel test Detailed Answer: Dear XXXXXXX A positive ANA at strong titre of 1 in 640 with Raynauds phenomenon (toes turn blue when cold), muscle pains, photosensitive rash already fulfills the criteria for SLE. For a definite SLE diagnosis, you will need to test for individual antibodies that is available in the ANA antibody panel (Ro, La, RNP/Sm, Jo-1, Scl-70) as a particular positive antibody would give a proper diagnosis. ds-DNA levels with CK levels will also be required. Disease activity is measured by Hb TC DC, ds-DNA levels, Urine Routine, C3 C4 levels. You will need systemic treatment with steroids, creams for the rash, steroid lowering regimens such as hydroxycholoroquine (HCQS). Discuss with your Rheumatologist whether these tests are available, and to start on definitive treatment. I have no idea why he has requested a second opinion. It may be to check whether the special tests are available or not. Best Wishes.
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Follow-up: What is the cause for toes turn blue, muscle pain in chest, arms, legs, and back, rash on face and arms? 13 hours later
I did have lupus test and RA test they came back negative but that's all he tested me for. I do have cream that the dermatologist sent me but he thinks it's related to lupus because it's in my arms, face, and back red and all year round. Muscle pains that in chest, upper back, and lower back, pain in legs, toes turn purple with cold, er visit due to migraine for four days and neck pain leading to lower face having a tingling numb feeling that I still have since last month. My pcp and dermatologist think lupus and rheumatologist just checked my blood for lupus and RA. What other rheumatologist is recommended to find what is wrong with me? He just told me go to university of pa or XXXXXXX XXXXXXX and see rheumatology what do I do? here are my test. They are normal but I am not ok. ANA PATTERN SPECKLED PATTERN THYROID AB GROUP [THYRAB CPT(R)] ANA [86038.02 CPT(R)] ANTI-DNA AB, DOUBLE STRANDED [86225.06 CPT(R)] SSA-SSB ANTIBODY [SSASSB CPT(R)] SCL-70 AB [86235.03 CPT(R)] RNP-SM ANTIBODY [86235.04 CPT(R)] COMPLEMENT C3 [86160.01 CPT(R)] COMPLEMENT C4 [86160.02 CPT(R)] RHEUMATOID FACTOR [86431 CPT(R)] CCP IGG AB [83520.02 CPT(R)] CBC/DIFF [CBCD CPT(R)] COMPR METAB PANEL [80053.01 CPT(R)] ROUTINE URINALYSIS [81002 CPT(R)] These are the results DS ANTI-DNA AB <10 <10 TITER SSA AB 1.6 <20 Units NEGATIVE SSB AB 2.3 <20 Units NEGATIVE SCL-70 AB 2.8 <20.0 Units NEGATIVE RNP AB 1.5 <20 Units NEGATIVE SM AB 1.8 <20 Units NEGATIVE COMPLEMENT C3 142 90 - 180 mg/dL COMPLEMENT C4 24 10 - 40 mg/dL RHEUMATOID FACTOR 11 <14 IU/ml CCP IGG AB <16 <20 UNITS NEGATIVE WBC 6.41 4.00 - 10.80 K/uL RBC 4.44 3.85 - 5.15 M/uL HGB 12.7 12.0 - 14.5 g/dL HCT 38.8 36.0 - 44.5 % MCV 87.4 81.5 - 97.5 fL MCH 28.6 27.0 - 34.0 pg MCHC 32.7 32.0 - 36.0 g/dL RDW 13.1 11.5 - 15.5 % PLATELET COUNT 246 140 - 400 K/uL MPV 10.3 6.6 - 11.1 fL SEGS 62 40 - 75 % LYMPHS 28 18 - 42 % MONOS 7 1 - 11 % EOS 3 0 - 6 % BASOS 0 0 - 2 % ABS. SEGS 3.94 1.8 - 7.7 K/uL ABS. LYMPHS 1.81 1.0 - 4.8 K/uL ABS. MONOS 0.44 0.0 - 1.1 K/uL ABS. EOS 0.19 0.0 - 0.7 K/uL ABS. BASOS 0.01 0.0 - 0.2 K/uL BUN 17 6 - 20 mg/dL CREATININE 1.0 0.5 - 1.0 mg/dL GFR should be used to assess renal function. Plasma/Serum creatinine may not be able to properly reflect renal function in some cases. GFR ESTIMATED >60.0 >60 mL/min SODIUM 138 135 - 146 mmol/L POTASSIUM 4.1 3.5 - 5.1 mmol/L CHLORIDE 102 98 - 111 mmol/L CO2 24 22 - 32 mmol/L ANION GAP 12 7 - 15 mmol/L GLUCOSE 87 70 - 120 mg/dL ALBUMIN 4.9 3.8 - 5.0 g/dL AST 18 10 - 35 U/L ALKALINE PHOSPHATASE 57 0 - 153 U/L BILIRUBIN, TOTAL 0.2 0.3 - 1.3 mg/dL L CALCIUM 9.5 8.3 - 10.5 mg/dL PROTEIN 7.0 6.0 - 8.3 g/dL ALT 15 10 - 35 U/L COLOR, UA STRAW YEL A CLARITY, UA SLIGHTLY CLOUDY CLEAR A GLUCOSE, UA NEGATIVE NEG mg/dL BILIRUBIN, UA NEGATIVE NEG KETONE, UA NEGATIVE NEG mg/dL SPECIFIC GRAVITY 1.012 1.003 - 1.030 BLOOD, UA NEGATIVE NEG PH, UA 6.0 5 - 6 units PROTEIN, UA NEGATIVE NEG mg/dL UROBILINOGEN, UA NORMAL NORM EU/dL NITRITE, UA NEGATIVE NEG ESTERASE, UA SMALL NEG A BACTERIA, UA NONE WBC, UA 30-49 /HPF RBC, UA 1-4 /HPF PROTEIN, RD URINE 11 mg/dL CREATININE, RD URINE 80 mg/dL PROT/CREAT RATIO 0.14 0.00 - 0.14 this was all done 7/31/2013 was not on blood since. What other test can be done?
Answered by Dr. Sujoy Khan 9 hours later
Brief Answer: Currently 3 of 11 SLE criteria fulfilled Detailed Answer: Dear XXXXXXX Many thanks for sending the results through to me. It appears that you now have (1) photosensitive rash; (2) some neurological symptoms that may or may not be due to SLE; (3) Positive ANA; (4) maybe discoid rash Discounting No 2 you have 3 of 1 criteria for SLE and hence the diagnosis is NOT SLE at this stage. Autoantibodies for specific disorders that overlap with SLE are negative. What you have not had are (1) anti-cardiolipin antibodies; and (2) lupus anticoagulant test that are now part of the criteria. Details of criteria in link below: WWW.WWWW.WW Treatment can be started as per incomplete SLE (possible SLE), although it is good that there is no renal involvement (note however Serum creatinine is high but just normal 1.0) as per urine protein leak is concerned. I would discuss with your Rheumatologist whether he would like to start on HCQS to see the response. Meanwhile, continue religiously on sun creams and steroid creams povided by your Dermatologist. Best Wishes.
Above answer was peer-reviewed by
Follow-up: What is the cause for toes turn blue, muscle pain in chest, arms, legs, and back, rash on face and arms? 28 minutes later
Thank you for explaining out of the 11 i have these that we know of: malar rash: butterfly-shaped rash across cheeks and nose Photosensitivity: skin rash as result of unusual reaction to sunlight Discoid (skin) rash: raised red patches Antinuclear antibodies (ANA): a positive test in the absence of drugs known to induce it. Arthritis (nonerosive) in two or more joints, along with tenderness, swelling, or effusion. With nonerosive arthritis, the bones around joints don’t get destroyed. I have this in my hips due to hip dyplasia but my hands and feet swell everyday and turn blue my toes from being cold everyday many times in a day I have to dress warm in my home yet i have it at 72. Thank you for responding to me I will continue with the creams dermatology sent me, taking the NABUMETONE 500 MG PO TABS 1 TABLET TWICE DAILY that rheumatology sent me. So I have symptoms but not test saying positive, does it look lupus related like my two doctors think? or should I seek the other rheumatologist? My rheumatologist suggested to see a rheumatologist in a specific area he is puzzled and wants me to do a study with a rheumatologist / hospital. What is the difference?
Answered by Dr. Sujoy Khan 7 minutes later
Brief Answer: You fulfill 5 criteria Detailed Answer: Hello, I have no idea how to answer your last question, as to what study your Rheumatologist is seeking. Certainly a MRI brain or the ACL antibodies, lupus anticoagulant, CK levels can be checked at this stage. For the Raynauds, Nifedipine 10mg should suffice, but keep warm over the next 3-4 months. A long acting antihistamine such as Fexofenadine will help with the swellings. Again, HCQS can be tried for 4-6 months to see whether you improve as I think you certainly will. Best Wishes.
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